(Philadelphia, PA) - Americans in small towns are statistically as likely
to die from gunfire as people in major cities, according to a new study
from the University of Pennsylvania School of Medicine
- with one key distinction. “The difference is who does the shooting,”
says lead author Charles C. Branas, PhD, Assistant Professor
of Epidemiology. Branas and colleagues found that when looking at all
deaths by firearms, the risk of being murdered with a gun in large cities
and the risk of committing suicide with a gun in rural areas were almost
identical. In fact, the risk of gun suicide in rural areas was slightly
higher than the risk of gun homicide in major cities.

After adjusting for income, education, employment rates, and other factors,
the most rural counties had over 1.5 times the rate of gun suicides compared
to the most urban counties. At the same time, urban areas experienced
almost twice the gun homicide rate of the most rural counties. Similar
trends were not found for other, non-gun forms of suicide or homicide.

The investigators analyzed urban-rural differences in intentional firearm
deaths-homicides and suicides-using over 580,000 death certificates from
1989 to 1999 in all counties in the United States. Their findings are
reported in the October issue of the American Journal of Public Health.

Over the last decade, gun suicides have outpaced gun homicides, accounting
for over half of all firearm deaths in the United States. Even with that
in mind Branas says that “gun suicide has become the forgotten side
of all of this, and to reduce gun death in general we have to start making
gun suicide a priority.”

In the 1990s, a great deal of legislation was aimed at reducing gun homicide,
which decreased in the United States by about 5 percent per year. Much
of this decrease was in big cities. But almost no attention has been paid
to gun suicide, which increased by about 1 to 2 percent per year, most
starkly in rural areas, over the same period.

“Ultimately we need to bring gun suicides out of the closet and
raise public awareness about these tragic events,” says Branas.
“We have to think more broadly about preventing gun suicide, especially
in rural communities, through such efforts as better detection of mental-health
problems and reduced access to guns for people who are known to be at
risk for suicide.”

Gun death should be broadly thought of as a public health issue, adds
Branas, since it includes gun suicide, which often falls outside the bounds
of the criminal justice and medical-care systems. “Killing yourself
with a gun is not a crime and the results are so immediate that a hospital
is very often bypassed for the morgue,” he says.

The study also found that the same trend for gun death did not hold true
for urban- versus-rural differences in non-gun methods of suicide or homicide.
Thus, guns clearly functioned differently from other methods. But why
the urban-rural difference? “We didn’t directly account for
differences in availability of guns by location, but we can speculate
how that might have affected our results,” says Branas, referring
to the larger percentage of gun owners in rural areas versus cities. “A
major take-home message from these findings is that although prevention
efforts must be continued in big cities, dispelling the urban myth that
gun death does not touch areas outside of big cities should be a high
priority.”

This work was funded by grants from the National Institute on Aging and
the Chicago-based Joyce Foundation. Other Penn researchers contributing
to the study are Drs. Michael L. Nance, Michael R. Elliott, Therese S.
Richmond, and C. William Schwab.

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